Provider Demographics
NPI:1558621565
Name:CARRIE F SHORT
Entity Type:Organization
Organization Name:CARRIE F SHORT
Other - Org Name:IN-FOCUS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:918-742-1275
Mailing Address - Street 1:6202 S LEWIS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1099
Mailing Address - Country:US
Mailing Address - Phone:918-742-1275
Mailing Address - Fax:918-742-7020
Practice Address - Street 1:6202 S LEWIS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1099
Practice Address - Country:US
Practice Address - Phone:918-742-1275
Practice Address - Fax:918-742-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200199870BMedicaid